1. Field of the Invention
The invention relates generally to tools for removal of fecal impactions and particularly to such a tool configured for ease of useage and safety of operation for rapid and reliable removal of a fecal impaction.
2. Description of the Prior Art
Patients often present in clinical settings with impacted stools that can only be evacuated spontaneously with extreme difficulty if at all. Such blockages are typically referred to as fecal impactions and result from the inability to spontaneously empty the rectum of accumulated stool. A fecal impaction occurs due to excessive and continuing fecal mass accumulation in the rectal vault such that the large and growing fecal bolus cannot be readily passed through the anus. The impaction worsens as additional stool is produced and typically hardens with drying of distal portions of the impacted stool, thereby creating an increasingly uncomfortable and potentially dangerous emergency condition. Medical intervention is often required for removal of the impaction from the rectum especially once the density and mass of the accumulating stool precludes passage spontaneously.
While fecal impactions can occur in otherwise healthy individuals, those suffering from certain medical conditions including neuromuscular diseases and severe debilitation as well as those in the general geriatric population are susceptible to the spontaneous development of fecal impactions. Accordingly, fecal impaction is a commonly encountered condition in patients not only presenting in an emergency situation at a medical facility but also for patients hospitalized for other conditions.
Current clinical practice typically relies on repeated insertions of a finger of a medical practitioner through the anus and into the rectum of a patient for removal of the impaction. Practitioners called upon to accomplish this task include nurses, paramedics, medical technicians as well as physicians. As presently practiced, a clinician inserts a gloved finger through the patient's anus and into the rectum in an effort to manually dislodge the stool mass either entirely or in fragments. The gloved finger probes the fecal mass in an effort to break up the mass followed by retrieval of fragmented portions of the mass. The patient may become capable of spontaneous defecation once a sufficient portion of the mass has been removed manually. Removal of such sufficient portions or of the entire mass usually necessitates repeated manual interventions coupled with supplemental use of one or more fluid enemas. Hospital admission may be required for more intensive efforts to free an impaction.
Manual manipulation of an impacted fecal mass is subject to failure since utilization of a single, gloved finger weighs against application to the impaction of a mechanical advantage sufficient to relieve the condition. A finger is simply not configured to grasp the fecal mass or to gain attachment thereto due to the shape of a finger and the inability to frictionally engage the mass. Probing of the fecal mass with the finger of a clinician involves blind sweeps and stirring motions that are not easily directed advantageously and thus can prove ineffective. Patient discomfort is often increased by attempts of the attending clinician to curl the inserted finger in an effort to improve connection with the fecal mass. This flexion motion, though essential to the effort to grasp a portion of the fecal mass, causes further distention of an already distended bowel. Pain thus unavoidably accompanies inefficiency during attempts to remove the impaction and often results in the necessity to abort the procedure. Once an ineffective manual procedure is discontinued, hospitalization for repeated enema treatment becomes necessary with reliance then being placed on hydrodynamic dissolution of the impaction.
Such manual techniques while imperfect are commonly used in spite of the existence in the prior art of devices of varying complexity intended to address the task of fecal impaction removal. Examples of such devices include the apparatus disclosed by Klingenstein in U.S. Pat. No. 5,730,726, the disclosed apparatus comprising a shaft having flexible spines that can be bowed away from the shaft to engage the fecal mass after insertion into a patient's rectum. Smith, in U.S. Pat. No. 4,243,037, discloses a fecal impaction removal device comprising a plunger assembly adopted for introduction into the rectum of a patient and having prongs intended to engage an impacted fecal mass. In U.S. Pat. No. 3,316,912, Whitaker discloses a device insertable into the rectum followed by extension of a hinged scoop-like element intended to capture a portion of an impaction for removal. Sourwine, in U.S. Pat. No. 833,759, discloses a double loop handle connected to a distal and proximal dilator as well as expandable blade elements intended to permit more ready insertion and engagement of the impaction. Sims, in U.S. Pat. No. 1,448,158, discloses blades disposed closely along a shaft for insertion into the rectum with spreading of the blade after insertion to engage the fecal mass. The patents to Sourwine and Smith further disclose use of central channels in the respectively disclosed devices for introduction of enema solutions while said devices are contained within the rectal vault.
While fecal disimpaction devices have previously been suggested in the art, the art still experiences a need for a simple, inexpensive, safe and efficacious tool for removal of fecal disimpactions, the fecal disimpaction tool disclosed herein meeting these needs long-felt in the art through provision of a tool having distal and proximal dilators facilitating insertion into and withdrawal from the anus of a patient as well as flexible, arcuately configured finger-like elements formed of a flexible though non-elastic material collapsible against a central shaft during insertion and opening once within the rectal vault to engage the fecal mass for removal. The fecal disimpactor of the invention is shown to produce the functions and advantages thus referred to as is shown and described herein.